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Mailing Address: 2620 S. Parker Rd., Suite 272 Aurora, CO 80014 Tel: (720× 3478559 www.CenterForValuedLiving.com Fax: (720× 2076885 AUTHORIZATION FOR RELEASE OF INFORMATION Name: Date of Birth:
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Start by writing your full name on the first line. Include any titles or suffixes, such as Mr., Mrs., Jr., or III.
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On the second line, write the designated mailing address: "2620 S." This indicates the street number and name.
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On the third line, indicate the city where the mailing address is located. Write it in uppercase letters, separated by a comma if necessary.
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The fourth line should contain the two-letter abbreviation for the state where the mailing address is located. Again, write it in uppercase letters.
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On the fifth line, write the ZIP code for the mailing address. Include the five-digit postal code.
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Note: The provided address "2620 S" is a partial address and may not be sufficient for accurate delivery. Please ensure that a complete and valid mailing address is used.
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